Johnston Neil W, Olsson Marita, Edsbäcker Staffan, Gerhardsson de Verdier Maria, Gustafson Per, McCrae Christopher, Coyle Peter V, McIvor R Andrew
Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada.
Early Clinical Development Biometrics.
Int J Chron Obstruct Pulmon Dis. 2017 Mar 10;12:839-848. doi: 10.2147/COPD.S127146. eCollection 2017.
Common colds are associated with acute respiratory symptom exacerbations in COPD patients.
To determine exacerbation risk and severity in COPD patients with/without coincident self-reported colds.
Global initiative for chronic Obstructive Lung Disease stage I-IV COPD patients electronically transmitted respiratory symptom diaries to research staff daily between December 2006 and April 2009. Respiratory symptom worsening prompted contact by a study nurse and patient assessment to determine if a cold was present or an exacerbation underway. A composite daily symptom score was derived for each subject from diarized symptom data. The exacerbation/cold/virus relation was examined using a Poisson regression model, the relation of colds to respiratory symptom severity using generalized estimating equation models.
Daily diary transmission compliance of >97% enabled detection of all possible exacerbations. Among 262 exacerbations meeting Anthonisen criteria, 218 (83%) had cold-like symptoms present at their inception, but respiratory viruses were detected in only 106 (40%). Within-subject exacerbation risk was 30 times (95% confidence interval [CI]: 20, 47; <0.001) greater with colds present. Compared to cold- and virus-negative exacerbations (n=57), the mean increase in composite symptom score in those cold and virus positive (n=79) was 0.93 (95% CI: 0.61, 1.25; <0.001), cold-positive and virus-negative exacerbations (n=100) 0.51 (95% CI: 0.21, 0.81; <0.001), cold-negative and virus-positive exacerbations (n=26) 0.58 (95% CI: 0.23, 0.94; <0.001).
This study emphasizes the importance of colds in COPD exacerbation risk and severity, even in the absence of virus detection. COPD patients should act promptly when cold symptoms appear to facilitate early intervention for exacerbation prevention or management.
普通感冒与慢性阻塞性肺疾病（COPD）患者的急性呼吸道症状加重有关。
确定有/无同时报告感冒的COPD患者的加重风险和严重程度。
2006年12月至2009年4月期间，慢性阻塞性肺疾病全球倡议组织I-IV期COPD患者每天通过电子方式向研究人员传输呼吸道症状日记。呼吸道症状恶化促使研究护士联系并对患者进行评估，以确定是否存在感冒或正在发生加重。根据日记症状数据为每个受试者得出综合每日症状评分。使用泊松回归模型检查加重/感冒/病毒之间的关系，使用广义估计方程模型检查感冒与呼吸道症状严重程度之间的关系。
每日日记传输依从率>97%能够检测到所有可能的加重情况。在符合安东尼森标准的262次加重中，218次（83%）在开始时出现类似感冒的症状，但仅在106次（40%）中检测到呼吸道病毒。存在感冒时，受试者内部的加重风险高30倍（95%置信区间[CI]：20，47；<0.001）。与感冒和病毒阴性的加重（n=57）相比，感冒和病毒阳性（n=79）的患者综合症状评分平均增加0.93（95%CI：0.61，1.25；<0.0？？此处原文可能有误，推测应为<0.001），感冒阳性和病毒阴性的加重（n=100）为0.51（95%CI：0.21，0.81；<0.001），感冒阴性和病毒阳性的加重（n=26）为0.58（95%CI：；<0.001）。
本研究强调了感冒在COPD加重风险和严重程度中的重要性，即使在未检测到病毒的情况下也是如此。COPD患者在出现感冒症状时应迅速采取行动，以便于对加重进行早期干预，预防或管理。 （注：原文中“cold-negative and virus-positive exacerbations (n=26) 0.58 (95% CI: 0.23, 0.94; <0.001).”这部分后面的95%CI区间后缺少内容，推测是原文录入有误）
